Robert David Sullivan 2

Brown takes lead, universal health care takes a dive

Contradicting a Boston Globe poll of a few days ago that showed Martha Coakley ahead by 15 points and a slim plurality in favor of the health care reform bill now in Congress, Suffolk University has just released a poll with Scott Brown ahead by 4 points and a clear majority against health care reform.

If true, I wonder if the real reason "liberal lion" Ted Kennedy got re-elected all those times was that he was good at steering defense contracts to Massachusetts. 

Is the state really going to pull an Emily Litella and say "never mind" after giving Kennedy 47 years in the Senate? We'll find out on Tuesday.

Scott Brown as Goliath killer?

The American Spectator's Jeffrey Lord compares Republican Senate candidate Scott Brown to Harris Wofford, the Democrat who won a special Senate race in Pennsylvania in 1991 by focusing on the need for health care reform -- and whose victory presaged a Democratic win in the 1992 presidential election. In this case, however, Brown is standing athwart the current health care reform bill yelling "Stop!"

From the Spectator:

What does the emergence of Scott Brown really mean?

It means that win-lose-or-draw, Scott Brown is already the Harris Wofford of 2010. Like Wofford he has played the role of the little-known, no-chance David going up against a political Goliath with health care as his sling-shot. But unlike Wofford, Brown's sling shot is the promise of effectively stopping government-controlled health care in its tracks, while tying it Wofford-like to corruption -- an argument made easy by the Ben Nelson "Cornhusker Kickback." [See explanation here.]

As Massachusetts goes, so goes health care reform?

The New Republic's Jonathan Cohn leans on the Bay State's health care reform law to make the case for national reform:

Has reform solved the access problem in Massachusetts? No. Has it made the problem a lot less severe? Yes.

Bay State 3rd healthiest, alcoholic binges notwithstanding

The United Health Foundation's latest America's Health Rankings put Massachusetts in third place for overall goodness, behind Vermont and Utah. (Mississippi was last.)

The Bay State finished first in two "core measures": the percentage of the population without health insurance (a lowly 5.4 percent) and the per-capita number of primary care physicians (190 for every 100,000). We were second best in holding down obesity, immunizing infants, and having a low number of occupational fatalities.

Our worst ranking: our high incidence of "binge drinking" (17.6 percent) was worse than in 36 other states. 

A year ago, we were in seventh place. Oddly, one of our most improved categories was the percentage of children between 19 and 35 months old who have been immunized. We rose from eighth to second in the rankings, even though the percentage (83.9) was exactly the same. Are fewer children being immunized nationwide because of cuts in public health spending? Or are parents reacting to the questionable theory that vaccines can cause autism?

US should emulate Bay State health care reform, says MIT's Gruber

Via Ezra Klein, MIT economist Jonathan Gruber (subject of a CommonWealth Conversation in 2007) says that the Massachusetts health care reform law suggests that national reform can lower insurance premiums:

The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.

The medical mystery of McAllen, Texas

Harvard Medical School's Atul Gawande has a fantastic investigative piece -- with the structure of a detective novel -- in this week's New Yorker. "The Cost Conundrum" is about rising health care costs in America, but Gawande doesn't weigh the piece down with predictable quotes or eye-glazing statistics. Instead, he goes from hospital to hospital in McAllen, Texas, to find out how that city became the second most expensive for health care in the US. (Miami is first.)

Why, Gawande asks, does Medicare spend $15,000 annually per enrollee here (twice the national average)? And why does health care in El Paso, Texas, which has pretty much the same demographic profile, cost about half as much as in McAllen?

Spoilers below.

More health coverage doesn't necessarily mean more doctors

One challenge in extending health care coverage is that there may not be enough primary-care doctors to see new patients, according to Robert Pear in the New York Times. Massachusetts ranks near the top in physicians per capita, but our recent health care reform law is putting a strain on the supply:

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased.

“Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation.

In the Winter 2009 issue of CommonWealth, Harvard Medical School's Allan Goroll warns of "a vitually empty pipeline of new primary care doctors" (as opposed to specialists) and suggests that changing work conditions are discouraging medical students from entering the primary care field:

We get paid on a volume basis, not on a value basis. We get paid for how many people we see. We don’t get paid for how well the patient does, what value we create in the patient’s life, or the value we create in the health care system. This has created what many doctors call a kind of unsustainable treadmill existence of work, where there are rapid short encounters with many, many patients. There’s often inadequate time to do the job right. Doctors are unhappy. Patients are unhappy. Nobody benefits.

Everything you wanted to know about dying in Massachusetts

After our characterization as a "gloom and doom" organization, I hesitate to post this, but last week the state Department of Public Health released its Massachusetts Death 2007 report, and it's got some fascinating data in it. (See the press release here, or download the whole thing here.) 

The bottom line is that the death rate hit a record low in Massachusetts in 2007 (704 deaths for every 100,000 people) and that life expectancy hit a record 80.2 years. (See? Positive news!)

For only the second year, cancer was the leading cause of death, having overtaken heart disease -- which had been the leading cause since it overtook infectious disease in the late 1920s. See the dramatic change in the Powerpoint slide below. (The big spike in infectious disease deaths in the early part of last century coincided with an influenza epidemic.)

As the slide below shows, most major causes of death are much less frequent in Massachusetts than in the United States as a whole -- with the curious exception of nephritis, which refers to kidney-related diseases.

Doctor discipline low in Massachusetts, lowest in Minnesota

Massachusetts ranks 38th in the incidence of "serious" disciplinary actions against doctors, according to a report released yesterday by Public Citizen. The public interest group noted that physicians in Alaska, Kentucky, and Ohio were most likely to receive sanctions by state licensing boards in 2008. Disciplinary actions were the least frequent in Minnesota, South Carolina, and Wisconsin.

(Oddly, the New York Times reported over the weekend that Minnesota leads the nation in tracking food-related illnesses, and we already knew that Minnesota ranked first in voter turnout and in contested legislative races. It's kind of reassuring to see the Gopher State finish last in something.)

According to Public Citizen, there were 67 disciplinary actions (i.e., "revocations, surrenders, suspensions and probation/restrictions") against Massachusetts doctors last year, out of some 34,000 physicians licensed to practice in the state. In Ohio, which has about 39,000 doctors, there were 205 disciplinary actions.

Could it be that doctors in Massachusetts are simply more competent than those in Ohio? Public Citizen is guessing "no," and it speculates that not enough doctors are getting slapped anywhere in the US:

Absent any evidence that the prevalence of physicians deserving of discipline varies substantially from state to state, this variability must be considered the result of the boards’ practices. Indeed, the ability of certain states to rapidly increase or decrease their rankings (even when these are calculated on the basis of three-year averages) can only be due to changes in practices at the board level; the prevalence of physicians eligible for discipline cannot change so rapidly.

Moreover, there is considerable evidence that most boards are under-disciplining physicians. For example, in a report on doctors disciplined for criminal activity that we published recently, 67 percent of insurance fraud convictions and 36 percent of convictions related to controlled substances were associated with only non-severe discipline by the board.[

Orthopaedic surgeons warn of orthopaedic surgeon shortage

Here's something else to worry about in terms of health care:

According to two new studies presented at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), the number of patients requiring hip or knee replacement surgery is likely to soon outpace the number of surgeons who can perform the procedure....

In 2016, 46 percent of needed hip replacements and 72 percent of needed knee replacements will not be able to be completed.

The studies focus on two problems. First, there's a "decreased interest" in hip and knee surgery as a specialty among young doctors. The AAOS's proposed solution may not be a surprise to those who read my earlier post on Bay State dentists: "the key to stemming this supply-side crisis is for policymakers to reconsider the rates at which [surgeons performing] total joint replacements are reimbursed."

Another problem is that demand for hip and knee surgery is rising, particularly among relatively young people. The study by Dr. Steven Kurtz states that the need for such surgery is expected to rise the fastest among people between 45 and 54 years old (from 59,077 in 2006 to 994,104 by 2030). Kurtz does not offer a reason for this surge. Is it due to rising obesity rates, or more athletic activity among the middle-age set, or some combination of the two?